Posts Tagged ‘Health Insurance’

Get Paid to Take Your Medications

Sunday, February 9th, 2014

It seems strange, but you really might start getting paid by your insurer to take your medications, quit smoking, and go to the gym regularly.  According to Forbes magazine’s Robert Szczerba, we should watch for a big shift in the healthcare industry.  We currently have a “fee for service” model, where doctors and hospitals get paid for each service they provide.  But in “Why Your Insurance Company Will Pay You to Take Your Medicine,” Szczerba says that the shift will take us to a “fee for outcome” model instead.  This means that doctors and hospitals will get paid when their patients have a successful health outcome, no matter how many services they have provided.  This approach is meant to help lower overall healthcare costs and will reward patients and doctors with smaller “micro” payments rather than the large “mega” payments that providers currently receive.

Right now the healthcare system is way too focused on big money.  Medical students want to go into big money specialties and marketers target big money medical devices.  Large payments from insurance companies to doctors and hospitals encourages them to continue ordering more tests and doing more procedures.  When we have the mindset that more care is better and that we need intervention instead of waiting minor problems out, and doctors and hospitals get paid more for each intervention, it’s the “perfect storm” for America’s overuse of health care.  We use more services than anyone else but are certainly not the healthiest nation by far.  In order to make this overall change to the health care system, we as Americans have to change our mindset when it comes to healthcare, health insurance, and overall health.

Believe it or not, clinical health care is only a 20% factor in our overall health care.  Healthy behaviors actually account for 30% of a country’s overall health and 40% is made up of socioeconomic factors.  It’s more effective to focus on preventative care like smoking cessation, exercising, eating right, and properly taking prescription medications.  Close to 1/3 of prescriptions never get filled.  In most cases, it is cost effective to pay patients $1 per day for keeping up with heart or diabetes medication than it is to pay for their future problems related to not taking prescribed medications.  When doctors take a conservative and supportive approach to medical care by not ordering unnecessary testing and taking a wait and see approach when applicable, thousands of dollars can be saved.  Micro payments to doctors who are conservative encourages better behaviors all around and can lead to lower overall healthcare costs.  Those people who are truly sick will still receive the necessary testing and treatments in this new system.  But people who are a little bit sick or not really sick at all will be given a more conservative treatment approach to save money all around.  Health insurance companies will even be able to lower premiums when the system isn’t so misused and overpriced.

Uninsured Veterans May Be Helped by Affordable Care Act

Monday, November 11th, 2013

On this Veteran’s Day, The Washington Post reports that one out of every ten veterans does not have health insurance.  In Sarah Kliff’s article “One in 10 veterans lacks health insurance. Obamacare could change that.,” she says that the expansion of Medicare could be the biggest game changer for veterans without health insurance.  Despite the fact that the Veterans Health Administration is the biggest health care system in the United States, not all veterans are receiving care at their 1,700 hospitals.  Some veterans don’t qualify because they have to serve for 24 consecutive months in order to qualify for coverage from the Veterans Health Administration.  Others don’t meet other specific requirements, including disability and income.

There are 1.3 million veterans who do not currently have health insurance.  In addition to that, there are more than 900,000 veteran family members who are uninsured.  But veterans actually have a lower uninsured rate than the national average of 18%.  While 10% of veterans are uninsured, it doesn’t mean that all of those people don’t qualify for Veterans Health Administration benefits.  Some people don’t know they qualify, others think the process of applying is too complicated, and some veterans may live too far from the facilities to use them.  Those veterans who are uninsured are typically younger than insured veterans and have lower levels of education and higher rates of unemployment.  That isn’t really surprising, but explains in greater detail why some Veterans are uninsured.

So how might the Affordable Care Act help to insure some of these uninsured veterans?  A recent report estimated that 40% of those uninsured veterans will now qualify for Medicaid under the new poverty guidelines.  Unfortunately for some veterans, 24 states are not currently planning to expand Medicaid.  Even so, hundreds of thousands of veterans may be able to receive health insurance under the expanded Medicaid system.  Many of their family members will also qualify for insurance coverage.  Researchers also wouldn’t be surprised if the VA started changing their policies regarding health insurance coverage.  This remains to be seen of course because this is all uncharted territory, but expansion of health insurance overall might mean some expansion at the Veterans Health Administration.

What Does It Mean if Your Employer Has Self-Insurance?

Tuesday, May 28th, 2013

It costs a lot of money for employers to offer health insurance coverage to their employees.  Even so, they do it for many reasons including to remain a competitive employer, to show that they care for their employees, and often, because it is required by law.  In 2014, as even more employers will be required to offer insurance plans to their workers, they will also be hit with a healthcare tax from the Affordable Care Act.  In the Med City News article, “Why self-insurance is the best way to reduce the hit of the Obamacare tax,” Joseph Berardo discusses why so many companies are now self-insuring rather than using health insurance carriers.  This type of insurance gives employers more flexibility and allows multiple cost-cutting measures.  Companies can make a specific plan that works for their workforce, they are able to maximize their cash flow because they don’t rely on prepayment of claims, they save up to 3% right away with an exemption from state taxes, and they save money by not paying extra carrier charges like profit sharing.

Catastrophic claims are challenging for self-insured plans, so most companies buy stop-loss insurance that will cover unexpected catastrophic claims like the cancer treatment of an employee.  Small group insurance plans and individual health insurance plans could end up seeing greater increases in their premiums as more large employers start to self-insure and avoid tax increases.  This new health insurance tax will increase each year based upon the cost of premiums.  The Congressional Budget Office says the new taxes are likely to be passed on to consumers through increasing premiums rather than paid for by the insurance companies to which they are directed.  Increases will be around 2% next year and closer to 4% by 2023.

Those in the individual insurance market could see decade long increases of $5,000 for family coverage.  Family coverage increases for small group plans in the same time frame is around $6,800.  Larger employer premium increases for family plans over a decade are more than $7,000.  In addition to the increasing taxes, employers face some other challenges with the passing of the Affordable Care Act.  They have to offer more essential health benefits, more comprehensive coverage, they’re under the jurisdiction of the state, and they have to make sure that employees are getting a certain value for each dollar spent.  But self-insured plans avoid a lot of the downsides worrying employers about the changes starting next year.  Just as we mentioned in our blog earlier this month, many large employers are self-insuring to avoid following state regulations and taxes as well.  I don’t know if this is any type of solution to the health insurance crisis in America, but it is a trend likely to continue.

Man Denied Hospital Admittance, Not for Lack of Health Insurance

Wednesday, March 6th, 2013

There a tons of people worried about not getting health care services because they don’t have insurance, but what about not being cared for because the hospital is full?  A man in Japan just died because 25 different hospitals denied caring for him in his time of weakened health.  My first thought was that he didn’t have health insurance, but that wasn’t the case at all.  According to The Christian Post’s Jessica Rodriguez, the 75 year old Japanese man who died had lived somewhere north of Tokyo.  I also learned that he was denied emergency room care at the 25 different hospitals a total of 36 times in a two hour span in the article “25 Hospitals Turn Man Down: Man Dies in Healthcare Fiasco in Japan.”

The man lived alone and called for emergency help because he was having a severely hard time breathing.  Although the ambulance arrived in plenty of time and began caring for him, their calls to hospitals so the man could receive more in-depth treatment were denied.  Emergency workers spent two hours almost begging a hospital to take the elderly man, sometimes calling hospitals a second time as his condition deteriorated.  They finally found a hospital to take him in that was out of the prefecture in which he lived.  But the two hour delay in finding a hospital coupled with the farther drive to the one that would actually accept the man were too much for his body to handle.  He was pronounced dead soon after arriving at the only hospital that would accept him.

So why were these hospitals denying a man treatment, especially if it wasn’t because of a lack of health insurance coverage?  Each hospital said that they either didn’t have enough doctors working to care for all of the patients or they didn’t have enough beds to accommodate him.  Maybe they were not clear of his dire situation, but this lack of health care has likely caused a death that could have been prevented.  Supposedly, the city of Kuki has told its hospitals that they must increase their emergency room capabilities so that something like this doesn’t happen again.  But it makes me wonder if this is going to become a bigger problem in Japan.  Their population has been steadily growing, but their health care system may not be keeping up if this is the kind of treatment patients receive.

Election is a Win for Obama’s Health Care Changes

Wednesday, November 7th, 2012

One thing is abundantly clear after the Presidential election yesterday; Americans are divided politically.  Whether you are in the small majority of Americans happy with President Obama’s re-election or one of those who were hoping for a Romney win, you will likely be affected by changes in health insurance.  This win by Obama just about cements his health care reform changes, some of which have already taken effect.  Americans with pre-existing conditions can no longer be denied health insurance coverage because of their health problems.  Also, many more young adults are insured now because they can stay on their parents’ plans until age 26.

In the CNN Money article, “Obama’s re-election secures health care reform,” Emily Jane Fox says that while most of the changes will take place in 2014, some insurance changes will happen next year as well.  Even without the majority of the changes being in effect, the number of uninsured Americans decreased this year for the first time in four years.  Americans who are 19 to 25 and often uninsured are happy about the changes as well because 3.1 million more of them now have insurance.  The individual insurance mandate requiring most Americans to carry insurance doesn’t go into effect until 2014, but the following changes will happen next year.

In order to help pay for federal subsidies that lower and middle class Americans will receive to help pay for their health insurance, two Medicare taxes are going to start in 2013.  There will be a new surtax on wage income for people making more than $200,000 a year or couples making more than $250,000 a year.  Investors will also start getting charged a 3.8% tax on part of their capital gains and dividends.  The surtax will affect around 2.4% of Americans, or 4 million people at first.  That number is estimated to be 8.3 million, or 4.6% of households by 2022.  A $2,500 limit will be imposed on workers’ tax-deductible contributions to flexible savings accounts.  Employers will be required to offer health insurance when they have more than 50 employees who work for them full-time.  This last item will be required by 2014 and fines will apply if it isn’t adhered to.

Whether you supported President Obama or not, his health care changes are here to stay.  Some Americans will see very positive outcomes from their health insurance changing, while others are unhappy about the added taxes and the required health insurance coverage.  We’ll continue to follow this story as the mandates take effect.

Aetna Health Insurance Covers Prostate Cancer Drug

Saturday, September 29th, 2012

More prostate cancer patients will be receiving treatment with a newer cancer drug.  Previously, metastatic prostate cancer patients whose disease had spread to the brain or lungs were not able to receive Provenge.  Aetna health insurance did not pay for this course of treatment for patients whose cancer had spread to the brain, lungs, or liver.  They still don’t cover Provenge when patients’ cancer has spread to the liver, but have removed the exclusion for brain and lungs.  Toni Clarke’s Reuters story, “Aetna expands coverage of Dendreon drug; stock jumps,” says that the company who makes the drug has seen increasing stock prices because of this announcement.  Dendreon Corp.’s shares have increased ten percent.

Provenge was the first vaccine of its kind on the market when it was approved in April of 2010.  It is a personalized, therapeutic vaccine for cancer patients who have not responded to hormone therapy.  Unfortunately, the price tag of $93,000 per treatment coupled with physicians having trouble and confusion with reimbursement, hasn’t made it as popular as Dendreon thought it would be.  The company projected sales to be around $440 million in 2011, but they only saw around half of that.  Despite the controversy that Provenge has illicited, prostate cancer patients are hopeful that it will extend their life and improve the quality.  Initial clinical trials showed an increase of life expectancy of 4.1 months.  That increased survival time from 21.7 to 25.8 months.  With Aetna health insurance increasing the number of patients allowed to use Provenge, other insurers may follow suit to help cancer patients.

Health Insurance Reform Debate Surges On

Wednesday, July 11th, 2012

As was expected by Democrats and the Supreme Court, Republicans are still fighting against the Affordable Care Act, even after it was upheld as being constitutional.  According to Fox News’ “House GOP poised to hold vote on repeal of ObamaCare after Supreme Court ruling,” Cristina Marcos says that there should be a vote today about repealing the Affordable Care Act.  This is the 31st time that Republicans have held a vote hoping to repeal all or some portion of President Obama’s health care reform.  This is the 2nd time Republicans have tried to repeal the entire law; the other 29 votes since 2011 have been against specific parts of the reform.  Since the Senate is controlled by Democrats and President Obama certainly won’t sign any repeal of his health insurance, is this a good use of government time?

While Democrats are accusing Republicans of wasting time fighting this same fight over and over, Republicans argue that just because the Supreme Court said the Affordable Care Act was constitutional doesn’t mean that it is good for Americans.  Republicans say they will continue to fight against health care reform with which they disagree.  Five hours of floor debate was allotted for this discussion by the House Rules Committee on Monday.  The lawmakers used four and a half hours of their discussion on Tuesday and finished the rest today.  Republicans say that they will continue fighting against what is sometimes known as ObamaCare until they have the majority.  Democrats think that the time allotted for arguing over this same debate would be better spent talking about jobs or other important issues working right now because they are happy with the Affordable Care Act.

Health Insurance Not Likely to Pay for this Surgery

Friday, February 24th, 2012

Did you know that it’s possible to have surgery and make yourself grow?  A man from New York has undergone two surgeries now to make himself taller, and so far, they have been successful.  ABC News’ Denise Martinez-Ramundo and Bill Ritter talk about this cutting edge surgery in the story “New York Man ‘Grows’ Six Inches Through Surgery.”  He is 37 years old and wishes to stay anonymous until everything is complete and he knows that it was a success.

The man has gone from 5’6″ to 6′ tall through his leg lengthening surgeries.  In the surgery, the leg bone is broken in two and a metal rod is inserted right into the center of the broken bones.  This telescopic rod pulls the bone apart approximately one millimeter each day.  Soon new bone grows around the area and other body parts, like muscle, regenerate around it.  This surgery costs $85,000 and is not likely to be covered by health insurance, so you better be sure that it’s your wisest investment.  The healing process can take months as well.

Not many doctors in the United States perform this leg lengthening procedure, but one in West Palm Beach, Florida performed 650 of these surgeries last year.  While most were related to dwarfism or deformities, there are definitely a growing number of cosmetic surgeries as well.  Height dysphoria, or people unhappy with their height, is one of the only psychiatric disorders that a doctor can cure through surgery.  I bet health insurance companies are watching this story and waiting to see what the future holds for this kind of height increasing surgery.

Susan G. Komen For the Cure Suffers a Loss

Tuesday, February 7th, 2012

After the raging battle between Susan G. Komen For the Cure and Planned Parenthood last month, a top official from Komen has resigned.  The breast cancer charity organization revoked funding to Planned Parenthood because they are under investigation for using federal funding to pay for abortions.  It is against the law to do that, but Planned Parenthood has always asserted that they do not nor have they ever used federal funding in such a way.  Sadly, this political debate really affected women who use Planned Parenthood for an array of health care services.

The decision by Komen was reversed after a few days and heavy backlash across the country.  Komen’s Vice President for public policy, Karen Handel, resigned today because of this ordeal.  According to Ray Henry’s Associated Press article, “Komen exec quits after funding flap,” Handel fully supported the decision to cut funding and is displeased that Komen reversed their decision.  Handel believes the funding cut was in the best interest of both Komen and the women they help.

Nancy Brinker, the founder and CEO of Komen, says that the company has made mistakes in the past few weeks and is planning to learn from them and strive for better in the future.  Brinker denies the criticism that Komen gave in to anti-abortion groups and pressure from Republicans.  After a failed run for Governor in Georgia last year, Handel was brought on as Vice President at Komen.  She has never denied her anti-abortion stance and  source at Komen says Handel was the driving force in this funding cut decision.  Regardless of whose decision it was, the reversal not only helps millions of women with little to no health insurance get breast cancer screenings, it also brought in sizable charity donations for both organizations over the past few weeks.

Drink Coffee to Prevent Diabetes

Friday, January 20th, 2012

The Los Angeles Times published an article by Marni Jameson of The Orlando Sentinel about coffee preventing Type 2 Diabetes.  In “Coffee helps prevent diabetes, now scientists learn why,” the author says that scientists believe they have figured out why coffee helps prevent diabetes.  It is not new information that those who drink four cups of coffee a day lower their diabetes risk, but this is the first time that scientists think they have figured out why.

The substance hIAPP, human islet amyloid polypeptide, is linked to diabetes.  This new research out of China shows that coffee inhibits the substance hIAPP.  The Journal of Agriculture and Food Chemistry published the Chinese researchers’ study.  Many scientists have been trying to find a way to block hIAPP and this research found that the caffeine and caffeic acid in coffee significantly block hIAPP.  The pancreas of a diabetic has very high levels of that substance.

While it may be a stretch to suggest that health insurance companies will start recommending coffee drinking to their plan participants, they sure aren’t likely to deter them.  Four cups of coffee per day lowers the risk of Type 2 diabetes by 50%.  With each added cup of coffee per day, your risk is lowered by another 7%.  Since 95% of the cases of diabetes are Type 2, this is important research for everyone.  Paula Deen’s recent announcement that she is a Type 2 diabetic has the disease as a top headline in the news right now.  Eating healthy and exercising are great preventative measures, and it looks like we can add coffee to that list as well.